Journal of Feline Medicine and Surgery (2011) 13, 959e966

doi:10.1016/j.jfms.2011.07.021

Post-mortem findings in 54 cases of anesthetic

associated death in cats from two spayeneuter
programs in New York State
Jodie A Gerdin DVM1*, Margaret R Slater DVM, PhD2, Kathleen V Makolinski 3
DVM ,
Andrea L Looney DVM, DACVA4, Leslie D Appel DVM5, Nicole M Martin CVT3,
Sean P McDonough DVM, PhD, DACVP1

1
Department of Anatomic
Pathology, College of Veterinary
Medicine, Cornell University,
Ithaca, NY 14853, United States
2
Animal Health Services, ASPCA,
1717 South Philo Road, Suite 36,
Urbana, IL 61802, United States
3
Animal Health Services, ASPCA,
PO Box 1144, Orchard Park, NY
14127, United States
4
Upstate Veterinary Specialties, 222
Troy Schenectady Road, Albany,
NY 12210, United States
5
Shelter Outreach Services, 78
Dodge Road, Ithaca, NY 14850,
United States
Anesthetic-associated death (AAD) in cats is infrequent, but occurs far more
frequently than in people. Post-mortem investigations of AAD in cats are
uncommon, and results only sporadically published. Here we report the
findings in 54 cases of AAD in cats. Significant gross and/or microscopic
pre-existing disease, including pulmonary, cardiac, and systemic disease, was
detected in 33% of cases. Pulmonary disease was most frequently diagnosed
(24% of cases), and included cases of Aelurostrongylus abstrusus infection (9% of
cases). Heart disease, including two cases of hypertrophic cardiomyopathy, was
less frequent (11% of cases). Four percent died from surgical complications.
No significant gross or microscopic disease was detected in 63% of cases.
Additional studies are needed to determine if these findings are representative
of AAD in cats in other geographic areas or with access to veterinary care. This
study demonstrates that post-mortem investigation of AADs is an important and
worthwhile endeavor.

Date accepted: 19 July 2011 Ó 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

A
nesthetic-associated death (AAD) has been
variably defined as death occurring within
24 or 48 h of anesthetic administration, or
at any time, so long as the cause of death is relatable
to anesthesia.1e5 In human pathology, AAD investiga-
tions are often legally mandated. These investigations,
in combination with studies of anesthesia-associated
mortality risk, have been credited with making anes-
thesia safer for people over the past 70 years, reducing
the AAD rate in the US from roughly one per 1000
procedures to one per 100,000 procedures.6
Post-mortem investigations of animals with AAD
are uncommon, with few, sporadic reports of findings
on a small number of cases.7,8 Because there have been
no systematic investigations to examine the lesions,
diseases, or mechanisms of AADs in veterinary med-
icine, there is minimal information available on the
nature and frequency of lesions in animals that expe-
rience AAD. For instance, although it is an adage that
*Corresponding author. E-mail: jag56@cornell.edu
cats that die unexpectedly perioperatively often have
hypertrophic cardiomyopathy (HCM), no data exist
to support this statement. The lack of studies cannot
be blamed on lack of AAD cases, for although
AADs in day-to-day veterinary practice are relatively
rare events, the AAD rate for cats is approximately
2.4 per 1000 procedures.4 Although comparisons of
mortality data between humans and cats must be
done cautiously, due to differences in patient popula-
tions and different disease severity profiles, the anes-
thetic death rate for cats is roughly an order of
magnitude greater than that of people.9
The purpose of post-mortem AAD investigation in
veterinary medicine is to determine the cause of
death, primarily by ruling in or out surgical complica-
tion or concurrent disease complicated by anesthesia.
There are no known pathognomonic or even typical
gross or histopathologic findings for anesthesia-re-
lated deaths. As a result, post-mortem investigations
of AADs are likely to be either informative (ie, surgi-
cal complication or disease discovered) or neutral
(ie, no disease discovered).

1098-612X/11/120959+08 $36.00/0 Ó 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.
960 JA Gerdin et al
High quality, high volume spayeneuter organiza-
tions (HQHVSNOs) are surgical initiatives that per-
form sterilization of large numbers of dogs and cats,
and which meet or exceed established veterinary
medical guidelines of care.10 Investigating AADs in
cats served by HQHVSNOs offer a unique opportu-
nity to study the pathologic findings in cases of
AAD. Firstly, these programs perform the same surgi-
cal procedures on large numbers of cats. Together, the
two programs in this study spay or neuter more than
25,000 cats per year. The surgeries are planned, non-
emergency, elective procedures. Also, cats presented
to these clinics are ostensibly in good health, with
an assessed or assumed (in the case of cats unable to
be physically examined) to be of American Society
of Anesthesiologists (ASA) Physical Status Scale Class
I or II (Table 1). This degree of standardization reduces
or eliminates variables such as surgical procedure,
urgency of procedure, monitoring methods and
equipment, and general health status, variables which
have been shown to correlate with risk of anesthetic
death in animals.4 The rates of AADs in these two
HQHVSNOs are generally low, at 0.8 and 1.6 per
1000 procedures (LA and MS, personal communica-
tion); due to varying anesthetic protocols and proce-
dures as well as underlying health issues, AAD rates
likely vary in different practice settings. Finally, inves-
tigating AADs in this population of cats could also
yield important information about the health status
of cats with limited or no veterinary care.
Materials and methods
A retrospective study of post-mortem investigations
of AAD in domestic cats from HQHVSNOs was con-
ducted at Cornell College of Veterinary Medicine.
Cases of AAD were defined as death within 24 h of re-
ceiving anesthetic agents. Cases of AAD were submit-
ted from two HQHVSNOs. One, operating in central
upstate New York (CNY), submitted cases between
May 2009 and December 2010. The other, in the
greater New York City (NYC) area, submitted cases
between February 2009 and August 2010. Cats served
Table 1. ASA Physical Status Scale (http://www.
asahq.org/clinical/physicalstatus.htm).
Patient characteristics
Class I Normal, healthy
Class II Mild systemic disease
Class III Severe systemic disease
Class IV Severe systemic disease that is
a constant threat to life
Class V Moribund patient; not expected to
survive without surgery
Class VI, not applicable to veterinary medicine, is not
included.
by the HQHVSNOs included: owned cats from
low-income households, cats in shelters, unowned
cats with regular human supervision and/or interac-
tion (stray cat colonies, barn cats, etc), and un-
owned trapped feral cats. A variety of anesthetic
drugs, used in varying combinations at varying dos-
ages, were used by the programs over the course of
the study period.
All post-mortem investigations were conducted by
the Section of Anatomic Pathology. A complete nec-
ropsy, following standard procedures, was performed
within 12e48 h of receiving the body.11 Bodies were
received both fresh and frozen. In all cases, a full set
of tissues were collected and fixed in 10% formalin.
The tissues processed for histology were dependent
upon the gross findings in the case. In nearly all cases,
histologic examination of major organs, including the
heart, lung, brain, liver and kidneys, plus any lesions,
was performed in addition to the gross inspection. In
rare cases, histology was not performed as the cause
of death was conclusively determined from the gross
inspection (ie, hemoabdomen) or initial histologic
evaluation. In some cases, additional special stains
and immunohistochemistry were performed in order
to confirm or refute the differential diagnosis (eg, pan-
leukopenia, HCM, etc). The presence or absence of
significant disease, defined as pre-existing natural dis-
ease that would have increased anesthetic risk of
death, was determined by the pathologist in charge
of the case. At the end of the study period, all submis-
sion information, final necropsy reports, and all histo-
logic sections were reviewed by one of the authors
(JG). Rare discrepancies between the initial interpreta-
tion and those based on review (JG) were resolved by
a third evaluation (SPM) to arrive at a consensus
diagnosis.
Results
At the end of the study period, 56 cases had been sub-
mitted for necropsy by two HQHVSNOs. In two of
these cases, the cats died 6 or more days after anesthe-
sia and surgery. These cases, in which the cause of
death was determined to be septic peritonitis and
panleukopenia (feline parvovirus), respectively, were
excluded.
In total, 54 cases met the inclusion criteria for the
study, including 33 females and 21 males. Both popu-
lations of cases of AADs were composed primarily of
young adult cats weighing approximately 3 kg
(Table 2). From the CNY group, two cases were un-
owned cats, three cases were owned cats, and seven
cases were not specified. From the NYC group, 33
cases were unowned cats, and nine cases were owned
cats.
Fifty-two cases submitted were of cats that went into
cardiopulmonary arrest, within a period of minutes to
24 h, from the time of premedication administration.
Of the cats that arrested, two were resuscitated but
euthanased a short time later, due to persistent
 Post-mortem findings in 54 cases of anesthetic associated death in cats 961

Table 2. For all cases submitted, the body weight

was recorded at the time of necropsy. In many
cases, the age was estimated. In 10 cases, the
age was not given and was recorded as ‘adult’
at the time of necropsy.
NYC cats CNY cats
Weight (kg) n ¼ 42 n ¼ 12
Mean 3.0 3.2
Median 2.7 3.2
Range 1e5 1.8e4.3
Age (years) n ¼ 34 n ¼ 10
Mean 1.3 1.8
Median 1 1.25
Range 0.16e6.5 0.29e6

Fig 1. Photo of the lung, taken at necropsy, of a cat that had

cardiopulmonary arrest during induction of anesthesia.
neurologic deficits (non-responsiveness). In two cases, Multifocal to coalescing, tan to white, slightly raised, soft,
nodular areas bulge from the pulmonary parenchyma. On
the cats were euthanased within 24 h of anesthesia,
section the areas exuded off-white foam. Although this gross
due to failure to recover appropriately from anesthesia appearance is not pathognomonic for A abstrusus infection,
and surgery, characterized by persistent lateral recum- histologic examination confirmed this differential diagnosis.
bency and decreased responsiveness. Panleukopenia
infection was diagnosed prior to euthanasia in one of
these two cases. A abstrusus infection included two owned cats, two fe-
Twenty-eight cats died following administration of ral cats, and one cat from a shelter. Feline asthma was
a combination of pre-medications and induction diagnosed based on the presence of classic histologic
agents, prior to surgery. One cat died following ad- features of pulmonary smooth muscle hyperplasia
ministration of pre-medications alone. Four cats died and hypertrophy, peribronchial gland hyperplasia,
intra-operatively and 21 cats died postoperatively. and interstitial eosinophilic infiltrates (Fig 5).
Significant natural disease was identified in 18 Of the six cases of heart disease, there were two
cases (33%) based on gross and/or histologic findings. cases of HCM and four cases of lymphocytic myocar-
Surgical complication was discovered in two cases, ditis of unknown etiology. Cases of HCM were diag-
both of which had hemoabdomen and died postoper- nosed based upon a fresh heart weight of over 20 g
atively (4%). Post-mortem investigation did not reveal in addition to thickening of the left ventricular free
any significant gross or histologic lesions in 34 cases wall and septum, with or without concurrent thicken-
(63%). ing of the right ventricular free wall (Fig 6); the
Significant natural disease was detected and cate-
gorized as follows: pulmonary disease (n ¼ 13); car-
diac disease (n ¼ 6); systemic disease (n ¼ 4) and
central nervous system (CNS) disease (n ¼ 1). Five
cases had both heart and lung disease and one case
had both cardiac and CNS disease.
Over half of the cases with natural disease had pul-
monary lesions (n ¼ 13), including: Aelurostrongylus
abstrusus infection (five cases), asthma (three cases),
acute aspiration pneumonia (one case), and pneumo-
nia (four cases) with no clear etiology and varying
cellular infiltrates (eosinophils, lymphocytes, etc).
A abstrusus infection was often evident grossly, with
dozens of small, multifocal and randomly scattered
pale pink foci which exuded a foamy liquid (Fig 1).
Histologically, myriad eggs and L1 larvae in alveoli
and bronchi, respectively, were evident (Figs 2, 3
and 4). Rarely, 125 mm long adults, characterized by
a thin cuticle, coelomyarianepolymyarian muscula-
ture and a pseudocoelom containing intestines, were Fig 2. Histologic section of lung. Multifocally, alveoli are
seen in larger airways. Of the five cases of A abstrusus occluded by a combination of parasite eggs, larvae, and
infection, four came from the CNY area; cases of infiltrating leukocytes.
962 JA Gerdin et al
Fig 3. Histologic section of lung. Adjacent to a secondary
bronchus (central clear circular area), alveoli contain a combi-
nation of parasite eggs, larvae, and infiltrating leukocytes
(arrows). Note multifocal pulmonary arterial muscular
wall hypertrophy and hyperplasia (arrowheads). Peribron-
chial glands are also mildly hyperplastic.
diagnosis was supported by histologically subtle and
localized irregular and obtuse myocardiofiber branch-
ing.13 Lymphocytic myocarditis was only diagnosed
on histologic examination. In two cases, myocardial
toxoplasmosis was suspected, but organisms could
not be identified by immunohistochemical methods.
Systemic disease was diagnosed in three cases.
Panleukopenia was found in two cases, based on the
presence of necrotizing enteritis, and confirmed with
immunohistochemical staining for panleukopenia an-
tigen. Systemic toxoplasmosis, characterized by hepa-
titis and myocarditis with mixed inflammatory
infiltrates, was suspected in one case, although
Fig 4. Histologic section of lung. Filling alveoli are
A abstrusus eggs, macrophages, degenerate neutrophils,
and fewer lymphocytes. Eggs contain approximately a dozen
7e10 mm, pale eosinophilic, round blastomeres (arrows) or
nascent L1 larvae (arrowheads), characterized by a brightly
eosinophilic cuticle and basophilic stippled interior.
Fig 5. Histologic section of lung. Surrounding multiple
cross sections of a secondary bronchus are severely hyper-
plastic peribronchial glands which narrow the lumen (aster-
isks). Smooth muscle in the surrounding parenchyma is
moderately to severely hypertrophied and hyperplastic
(arrowheads). The pulmonary arteries in this case were
also tortuous, evidenced by increased numbers of cross sec-
tions; the tunica media of pulmonary arteries is also moder-
ately hyperplasic and hypertrophied (arrows).
organisms could not be identified by immunohisto-
chemical methods.
CNS disease, specifically meningoencephalitis, was
diagnosed in one case, based on the presence of lym-
phocytes, plasma cells, and histiocytes in the cerebrum
and meninges. Again, toxoplasmosis was suspected,
but tachyzooites could not be demonstrated in areas
of inflammation by immunohistochemical methods.
Fig 6. Cross section of a fresh heart from a domestic short-
hair cat with HCM. The width of the left ventricular free
wall and septum is severely increased, and the diameter of
the left ventricular lumen severely decreased (concentric
hypertrophy). The right ventricular free wall width is within
normal limits. This heart weighed 24 g; the body weighed
4.05 kg. Scale in centimeters. Photo courtesy Dr Tim Cushing
DACVP.
 Post-mortem findings in 54 cases of anesthetic associated death in cats
Hepatic lesions were noted only in three cases, and
only by histologic examination. All three cases dem-
onstrated multifocal random hepatitis. In one case,
toxoplasmosis was suspected as myocarditis was
also noted. In the other two cases of hepatitis, small
foci of neutrophils with hepatocyte loss, along with
hepatic extramedullary hematopoiesis, were the only
lesions noted. These lesions were not considered ex-
tensive enough to have contributed significantly to
death.
The two cats diagnosed with postoperative he-
moabdomen were both were female, and all ligatures
were in place. Additional evidence of a bleeding di-
athesis, such as significant hemorrhage or petechia-
tion in other locations (body wall, skin, mucous
membranes) was not noted.
None of the 54 cases included in the study had sig-
nificant gross or histologic evidence of renal disease.
Discussion
Our results demonstrate that post-mortem investiga-
tions of animals with AAD can yield important infor-
mation about occult infectious and idiopathic disease,
especially lung, heart, and systemic infections.
Although this study was limited to cats with minimal
access to veterinary care, including feral cats, the find-
ing of a high frequency of occult pulmonary disease
also has implications for surgical candidates that are
recently adopted stray cats or owned cats that spend
a large percentage of time outdoors.
A abstrusus and anesthesia
The high frequency of cases of A abstrusus was unex-
pected. The reported prevalence of infection rates of
A abstrusus in domestic cats varies widely among
studies (1e22%), due to differences in the studies’
geographic area, methods of detection, and the nature
of the populations studied e owned versus stray
cats.14 Some studies suggest that stray cats have
higher rates of infection.14,15 Interestingly, an equal
number of owned and feral cats were diagnosed
post-mortem with A abstrusus infection in this study.
A abstrusus is a metastrongyloid nematode parasite
with worldwide distribution. Adult worms reside in
the terminal bronchioles of cats, the definitive host.
Females lay eggs which molt into first stage larvae
(L1) in alveoli. These L1 larvae are then coughed up
and eliminated through the feces, which contaminate
the environment and infect gastropods (snails and
slugs), the intermediate host. After molting to the
third larval stage (L3) in intermediate hosts, L3 larvae
are infective for cats, but L3 larvae are also carried by
paratenic hosts: birds, rodents, frogs and lizards. L3
larvae ingested by cats migrate from the intestine to
the lung, and develop into adult (L5) worms. Eggs
are deposited in cats’ lungs 25 days after infection;
however, it takes 40 days for L1 larvae to develop
and pass in the feces where they can be detected.16
963
Cats eliminate the infection after approximately
5 months and cannot be re-infected.17 Clinical disease
in infected cats is rarely reported, but can include
coughing, dyspnea, bronchopneumonia, and in rare
cases, spontaneous pneumothorax. The gold standard
for diagnosis is a Baerman fecal examination.18 In this
study, a majority of the cats diagnosed post-mortem
with A abstrusus came from the CNY area; this may re-
flect differences in food sources available, with greater
access to paratenic hosts in more rural areas.
A abstrusus infection in cats results in granulomatous
pneumonia. A combination of eggs, L1 larvae and mac-
rophages fill alveoli, reducing available surface area for
gas exchange (Fig 2). A abstrusus infection also results in
hypertrophy and hyperplasia of the tunica muscularis
of pulmonary arteries and smooth muscle hypertrophy
throughout the lung.19 In one study of experimental in-
fection, these changes were shown to persist for over
a year.20 Hypertrophy and hyperplasia of the smooth
muscle of pulmonary arteries is also induced by
Dirofilaria immitis infection in cats, and has been shown
to result in pulmonary hypertension.21 Although pul-
monary hypertension has not been conclusively dem-
onstrated in cats with A abstrusus, it is reasonable to
suspect it occurs, based on the similarity of vascular
changes. No gross or histologic evidence of right ven-
tricular free wall hypertrophy, a sequelae of chronic
pulmonary hypertension, was noted in any of the cases
of A abstrusus infection; however, the relationships be-
tween the duration and degree of pulmonary hyperten-
sion and effect on the right ventricular free wall
thickness is not well characterized in cats.
In people with pulmonary hypertension, anesthetic
drug-induced decreases in heart rate and/or systemic
blood pressure result in a sudden drop in pulmonary
perfusion, and an attendant decrease in the volume of
blood returned to the left ventricle.22 Similarly, when
sedated or anesthetized, cats infected with A abstrusus
may no longer be able to compensate for decreased
gas exchange surface area and (presumed) pulmonary
hypertension, resulting in a precipitous drop in blood
oxygen saturation and decreased left ventricular fill-
ing. With lung perfusion and ventilation significantly
compromised, these cats would rapidly succumb to
a combination of hypoxia and systemic hypotension,
culminating in cardiovascular collapse and arrest.
Unfortunately, the prevalence of A abstrusus in the
populations studied is unknown, as is the percentage
of cats infected with A abstrusus that survived anesthe-
sia and surgery. Disease prevalence investigations into
this population of cats could help clarify the role of
this parasite in AADs.
Other lesions
The proportional mortality ratio of HCM within the
AAD study group was 4% (2/54). The small number
of cases would seem to contradict the adage that
AADs are often due to HCM. The etiology of the
four cases of lymphocytic myocarditis is unknown,
964 JA Gerdin et al
and although toxoplasmosis was often suspected in
these and other cases, tachyzooites were not detected
using immunohistochemical stains. However, the
small size of the infective form of Toxoplasma gondii, ta-
chyzooites, measure approximately 5  2 mm, which
makes identification challenging in the majority of
toxoplasmosis cases. Only a few of the tiny T gondii
tachyzooites are needed to incite significant inflamma-
tion however, and so the absence of organisms in his-
tologic section does not conclusively rule out this
differential diagnosis. Additional diagnostic tech-
niques such as polymerase chain reaction (PCR)
would have been more sensitive for detection of
T gondii organisms had cost not been a constraint in
this study. Differential diagnoses for primary lympho-
cytic myocarditis in cats also includes Bartonella hense-
lae, a wide variety of systemic infectious agents may
spread to the heart. Myocarditis may also be seen in
association with cardiomyopathy, although no other
evidence of cardiomyopathy was seen in the four
cases of lymphocytic myocarditis.
In the two cases of hepatitis with small foci of neu-
trophilic infiltration and hepatocyte loss and extrame-
dullary hematopoiesis, an acute bacterial shower from
portal blood was suspected, as was infection with
Mycoplasma haemofelis. However, neither case had ad-
ditional histologic changes, such as icterus, splenic he-
mosiderosis, or lymphadenopathy, to support
a diagnosis of M haemofelis.
Finding cases of panleukopenia in this population
of young, largely unvaccinated cats were unsurpris-
ing. Clearly, more studies of cats with AAD need to
be investigated to determine if the population studied
here is representative of AADs of owned cats with
regular veterinary care.
Both cases of hemoabdomen were diagnosed in fe-
males, and no other evidence of a bleeding diathesis
was noted at necropsy. As all ligatures were in place,
we suspect that an ovarian or uterine artery retracted
proximal to the level of the ligature, effectively releas-
ing the artery from ligation. Alternatively, ligatures
may not have adequately constricted the artery.
Cases without gross or histologic findings
The implications in cases without gross or histologic
findings are limited. What can be said conclusively
is that death occurred in association with anesthesia,
and no gross or histologic evidence of significant,
complicating disease was detected. Ultimately, these
cases are best labeled as ‘AAD of unknown etiology’.
Note that this categorization only specifies the cir-
cumstances of the death, and is not the same as or
tantamount to concluding that death was solely or
primarily due to anesthesia.
All parties involved in an AAD investigation should
be aware that many fatal anesthetic complications can-
not be detected by post-mortem investigations. These
include mechanical causes of death such as upper air-
way occlusion by the soft palate or improper
endotracheal intubation, biochemical derangements
such as respiratory acidosis secondary to hypoventila-
tion, and cardiac conduction abnormalities. It is impor-
tant to note that proving death due to drug-specific side
effects or anesthetic overdose, using post-mortem toxi-
cological analysis, is currently not feasible in veterinary
medicine.
Cases of AAD with occult disease were diagnosed
as ‘AAD with [disease entity],’ because it is the an-
esthetic effects in combination with the disease
state(s) that precipitate death. Complicating dis-
eases considered significant should be limited to
those body systems which are affected by or have
a profound effect upon anesthesia, including the re-
spiratory system, cardiovascular system, nervous
system, and renal and hepatic (drug-metabolizing)
systems. Systemic disease states, including both in-
fectious and non-infectious diseases (neoplastic, id-
iopathic, etc), also have the potential to have
a profound impact on anesthesia and risk, as re-
flected in the ASA Physical Status Scale. Only in
those cases where the patient could be expected to
die regardless of anesthesia, can the anesthetic set-
ting of the death potentially be disregarded.2
Using standardized terminology in pathology re-
ports for cases of AADs will more clearly reflect the
nature and circumstances of the death, and allow eas-
ier identification of these cases and compilation of
data, so that population-based studies of risk factors
for AAD can be conducted in the future.
Study limitations
The amount of case-related information recorded in
Cornell’s necropsy data varied widely, in large part
due to the open-ended nature of the necropsy submis-
sion form. Unfortunately, the variability of informa-
tion submitted and protocols employed during the
study period limited the comparisons that could be
made regarding anesthetic drugs administered, doses,
and relationship to sex, age, weight, time to arrest, etc.
Towards the end of the study, a standard list of infor-
mation, useful from clinical, anesthesiologic, and
pathologic perspectives in cases of AAD, was devel-
oped (Table 3).
Also, although AAD was defined as death within
24 h of receiving anesthesia, postoperative monitoring
of all cats for a full 24 h could not be guaranteed, even
though it is recommended by the HQHVSNOs to care-
takers that cats be monitored for 48 h postoperatively
prior to release. Both HQHVSNOs have phone numbers
available to call if caretakers had questions or problems,
however. Therefore, cats that died or were euthanased
within 24 h were likely completely reported.
Finally, variation among pathologists is always
a concern in retrospective pathology studies. In this
study, differences were minimized by strict adherence
to the necropsy protocol and collection of a complete,
standardized set of tissues, although the tissues exam-
ined histologically varied among pathologists and
 Post-mortem findings in 54 cases of anesthetic associated death in cats
Table 3. Recommended submission information for cases of AAD. The type of arrest can be essential in
establishing the mechanism and cause of death.3 The percentage of oxygen in the lungs at the time of
death can have a profound impact upon the gross appearance at the time of necropsy and affect inter-
pretation (artifact or true lesion). Similarly, cardiopulmonary resuscitation (CPR) efforts, including drug
administration, may result in post-mortem artifacts.
Recommended submission information for cases of AAD
Signalment
Presenting complaint
ASA Physical Status Scale category/significant
physical exam findings (based on information
available prior to anesthesia)
Purpose of anesthesia/sedation (exam, surgery,
other procedure, etc)
Pre-anesthetic medications: drugs, doses, routes,
and times given
Induction drugs: drugs, doses, routes, and times given
Maintenance drugs: list drugs, doses, routes,
and times given
Endotracheal intubation (Y/N)
cases handled by the same pathologist. While having
all necropsies performed by an individual pathologist
may decrease variability, review by multiple patholo-
gists decreases the risk of a systematic bias in
interpretation.
Conclusion
We hope that this is the first in a series of studies of
the lesions and diseases that contribute to AADs in
cats, as well as other veterinary species. It is important
for clinicians to be aware of the utility of the necropsy
in AAD investigation, both as a means to discover
more information on an individual case-basis, and as
a contribution to the effort to make anesthesia safer
for all veterinary species.
Acknowledgements
Funding for post-mortem investigations was provided
in part by a grant from Pfizer Animal Health. Pfizer
Animal Health had no role in the study design, collec-
tion, analysis or interpretation of data, or in the writ-
ing of the manuscript, or in the decision to submit the
manuscript for publication.
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